It Turns Out 2020 Was Not The Year For Perfect Vision

Try to think back to late 2019, when the year of the ophthalmology meme was at our doorstep: “Eye see it now: you have 2020 vision!” But 2020 vision soon became a blur, and soon turned into 2020 hindsight, over and over again. Just ten weeks into the new year, children in the U.S. were sent home from school and sent to screens. But their counterparts in China had had a two-month jump on that, and sustained a complete lock down of all schools from January to May 2020. Approximately 220 million children in China went to online school at home for that period of time. Most children returned to school in June.

In many parts of China, children ages 6- to 13-years-old typically undergo annual vision screening during each school year. As the rise in myopia (nearsightedness) worldwide continues to increase, this had been a concern even prior to the coronavirus pandemic. The World Health Organization estimates that by 2050, half of the world’s population will be myopic. A notable risk factor, yes, even prior to the pandemic, is more time spent indoors.

In China, students are typically screened at the beginning of the calendar year, but in the 2019-2020 school year, this did not occur until June. Researchers based at Emory University, the University of Michigan, and Tianjin Medical University in Tianjin, China reviewed data from annual vision screenings of 6- to 13-year-old students between 2015 and 2020. Their work was published in this month’s JAMA Ophthalmology. They reviewed vision screenings of over 125,000 children over these past six consecutive years and their findings were crystal clear: the youngest children in the group had a significant decline in visual acuity, only in 2020.

In the 6, 7, and 8-year-olds, roughly equivalent to kindergartners through second or third graders in the U.S., there was a substantial increase in myopia compared to all years studied in 2015-2019. In prior years, the conglomerate incidence of myopia in 6- to 8-year-olds was in the 14% range, but it jumped to over 28% in 2020. The older children (9- to 13-year-olds) had no significant change in their incidence of myopia in 2020 compared to prior years. As lock down for many areas of China was quite rigid in the early months of the pandemic, meaning not only increased screen time but also decreased outdoor time for young children, the burden on the youngest group may have led to visual loss. While studies in the past have addressed the issue of outdoor time reducing the incidence of myopia, the current data in such a large group of young children better delineates that this is a real concern, especially in developing eyes.

Many parents and educators have rightly been concerned about the abundance of screen time use in both children and adults in the past year, as school work, homework, and work-at-home by adults as been nearly exclusively on a screen. Issues of eye strain, headaches, dry eyes, and sleep disorders have been some of the many sequelae of our screen-exhausted eyes and brains. But objective measures of vision loss, especially in young children, raises a potentially more permanent concern. Will these myopic eyes undergo some recovery, once they are back out in the world? The study group will likely continue to follow these children, to see if there is any malleability to the eye’s development in brighter years ahead. Until then, children and adults should continue to be cognizant of too much screen time, and when it’s safe, it’s always good to go outside and take in the sites and sights.